Thank you for your decision to apply for a travel nursing position with Hudson Staffing! Before we can offer you a nursing employment opportunity in the LPN field, an electronic skills assessment must be completed. Please, complete the nursing skills checklist below, and be sure to review your information thoroughly before clicking the submit button.

GENERAL INFORMATION

Note:* Denotes a required field.

Please enter your full name as it appears on your Social Security Card:

First Name

Middle Name

Last Name*

Please enter the Last Four digits of your Social Security Number:

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*

Please check here if you do not hold a valid social security card.

Please provide your contact information:

Phone Number*

E-mail Address*

Confirm E-mail Address*Type your e-mail address again above.

This profile is for use by healthcare professionals in the LPN discipline and specialty. It will not be a determining factor for the program.

AGE- APPROPRIATE CARE: Ability to adapt care to incorpor ate normal growth and development, adapt method and terminology of patient instructions as it relates to the age and comprehension level of the patient, and to ensure a safe environment refle

Age

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Newborn (birth- 30 days)

Infant (30 days- 1 year)

Toddler (1- 3 years)

Preschooler (3- 5 years)

School Age (5- 12 years)

Adolescents (12- 18 years)

Young Adults (18- 39 years)

Middle Adults (39- 64 years)

Older Adults (64+ years old)

Please read and agree to the statements below by marking the checkbox. You will not be able to submit until you have marked the checkbox.

* I attest that the information I have given is true and accurate to the best of my knowledge and that I am the individual completing this form. I hereby authorize Hudson Staffing to release this LPN Skills Checklist to the client facilities in relation to consideration of employment as a healthcare professional with those facilities.

Privacy Note: Hudson Staffing will record anonymous electronic information about your connection when you click on the submit button. This information is used for security purposes only. This information will include your IP Address (54.167.29.208) which will be used as a digital signature.